Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality in Postpancreatitis Diabetes Mellitus Versus Type 2 Diabetes: A Nationwide Population-Based Cohort Study

<i>Objective:</i><b> </b>Post-pancreatitis diabetes mellitus (PPDM) is a frequent complication of pancreatitis and associates with poor glycemic control. We investigated the risk of adverse diabetes related outcomes in PPDM compared to type 2 diabetes.<b> </b> <p><i>Materials and Methods:</i><b> </b>In this Danish population-based cohort study, we included adults (>18 years) with incident PPDM or type 2 diabetes between 1998 and 2018 through national health registries. PPDM was further divided into acute/chronic subtypes (PPDM-A and PPDM-C). We ascertained risk of major adverse cardiovascular events (MACE), severe hypoglycemia, and all-cause mortality as well as incidence rates of severe hypoglycemia. We compared risk and incidence rates across diabetes subgroups using multivariate Cox- and Poisson regression analyses.</p> <p><i>Results:</i><b> </b>We identified 383,325 people with incident type 2 diabetes, 3,418 with PPDM-A and 2,461 with PPDM-C. Compared to type 2 diabetes, PPDM-C was associated with increased risks of severe hypoglycemia (HR 5.27; 95% CI 4.62–6.00, P<0.001) and all-cause mortality (HR 1.54; 95% CI 1.45–1.64, P<0.001). Similar patterns were observed for people with PPDM-A. Incidence rate ratios (IRRs) for severe hypoglycemia were increased in both PPDM-C (IRR 7.38; 95% CI 6.75–8.08, P<0.001) and PPDM-A (IRR 3.76; 95% CI 3.36–4.21, P<0.001) compared to type 2 diabetes. Findings were consistent in an analysis restricted to people on insulin and in an analysis including pancreatitis patients without diabetes as comparator group.</p> <i>Conclusions:</i><b> </b>Compared to type 2 diabetes, PPDM is associated with excess risk of adverse diabetes related outcomes. This has important implications for management.